Acne Vulgaris - Dermatology - Lecture Slides, Slides of Dermatology

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ACNE VULGARIS

ACNE - Goals

 Decrease scarring

 Decrease unsightly appearance

 Decrease psychological stress

 Explain long length of treatment may

be several months and initial

response may be poor but must

persevere (poor compliance has been

demonstrated in studies at 3/12)

Acne Treatment

 Benzoyl peroxide-(cheap+cheerful)

 Start at low strength 2.5% at night

 Mild erythema-transient

 Warn it bleaches clothes

 Build up to 10% gradually

 Stop if irritation occurs

Acne treatment

 Topical retinoids

 Start low strength (0.025%)every

other night-may cause

redness/irritation

 Increase strength until response

 Avoid sunlight/uv light,not during

pregnancy

Acne treatment

 Azelaic acid cream-keratolytic

 Alters composition of fat/decrease

bacteria

 Short term use only

 May cause irritation/ photosensitivity

Acne Treatment

 Oral Antibiotics  Oxytetracycline 500mg bd

 Warn patient can take 6/52 for response- must be compliant.treat for 6 months  Avoid milk,and have 30mins before meals

 If effective reduce dose to 500mg od and then 250mg od at 3/12 intervals

 DO NOT GIVE WITH TOPICAL ABX- RESISTANCE.CAN COMBINE WITH OTHER TOPICALS

Acne treatment

 Hormonal

 In women on OCP consider less

androgenic progestogen eg marvelon/cilest, but increased risk of DVT

 Consider cyproterone acetate with

oestrogen(dianette) .NB endorse perscription with “OC” if patient using as a contraceptive(not licensed as a contraceptive)

Acne- referrals

 Refer if very severe or psychological

distress

 Specialists can prescribe

 ISOTREIN(Roaccutane)-specialist only

prescription.terratogenic+lots of side effects

 UV light

 Intralesional steroid injections

 High dose antibiotics